Core stability training for chronic non-specific lower back pain: A waste of time or still relevant?

A blog previously posted explored a 2012 systematic review looking at core stability training in the athletic population. This study found that isolated core strengthening may have positive impacts on athletic performance, but had some limitation in the study.

This blog will present 2 recent articles released about the effects of lumbopevlic stability training (LPST)/core strengthening in patients with chronic non-specific lower back pain (CNSLBP). It is quite common for physiotherapists and exercise physiologists to prescribe LPST exercises for patients with CNSLBP.

Literature over previous decades has showed CNSLBP can have a range of factors causing the patients symptoms, but it has been noted the effects of having an impaired core (Paungmali et al, 2016). In addition to the pelvic floor (supports our organs and makes bottom of abdominal cavity), the transverse abdominus (TrA) and lumbar multifidus are deep core muscles that have a primary role in lumbar spine stabilization.

When a person has lower back pain, wether it be chronic or acute it is very common for these muscles to either not activate correctly or ‘switch off entirely’. Paungmali and colleagues conducted research in 2015 comparing the effects of LPST (including specific exercises focusing on TrA contractions and training) to a placebo exercise in passive cycling (laying on back with legs doing cycling motion for you) and a control of just rest in patients with CNSLBP. The study included 25 participants (7 males and 18 females) and they looked at the short-term effects on TrA muscle thickness (looking with real time ultrasound) and effects on pain modulation.

Although it was a relatively small sample size for the study, the results were quite supportive of LPST. They found that the LPST provided significant therapeutic benefits as measured by an increase in the muscle thickness of the TrA at rest and during contraction (Paumgmali et al, 2015). Furthermore, LPST provided therapeutic effects as it improved the perception of pain beyond the placebo and control interventions. The pain intensity under the LPST condition was significantly better than that under the placebo and control interventions (Paumgmali et al, 2016). Both articles concluded that LPST may provide therapeutic effects in the short term in CNSLBP patients not only in pain perception, but also in TrA muscle thickness and activation.

As physiotherapy and exercise physiology are evidence-based professions, studies such as these help guide our treatments for CNSLBP. As evidence shows ‘hands on’ therapies from physiotherapists may be not indicated for most CNSLPB patients, studies such as these 2 show that LPST have positive effects on patients and should be considered in the management of lower back pain.